Chapter 12: Wrist and Hand Complex
radial tubercle (Lister's tubercle)
Acts like a pulley. Bone projection on dorsal aspect of distal radius; guides direction of several wrist and thumb extensor muscle tendons (EPL, ED and EI); Lister's tubercle separates the tendon of the ECRB from the EPL
D. Opponens pollicis
All of the thumb musculature attach to the first proximal phalanx EXCEPT for one muscle. Which of the thumb muscles attach to the first metacarpal? A. Abductor pollicis brevis B. Adductor pollicis C. Flexor pollicis brevis D. Opponens pollicis
Arthrokinematics: Distal Radioulnar Joint
Supination: Concave radius on convex ulna-concave ulnar notch glides posteriorly on the ulnar head
third metacarpal
The bone distal to the capitate is the: A. first metacarpal B. second metacarpal C. third metacarpal D. fourth metacarpal
trapezium
The carpal bone that articulates with the first metatarsal is the: A. capitate B. hamate C. trapezium D. trapezoid
styloid process
The distal, lateral bony process of the radius is known as the: A. extensor process B. flexor process C. Lister's process D. styloid process
C. scaphoid, trapezium, metacarpal
When palpating the wrist and hand, identify the order of the bones of the lateral row. A. scaphoid, capitate, metacarpal B. scaphoid, lunate, metacarpal C. scaphoid, trapezium, metacarpal D. scaphoid, trapezoid, metacarpal
convex on concave
When the proximal carpals move on the distal radius, the respective joint surfaces are: A. concave on concave B. concave on convex C. convex on concave D. convex on convex
convex; concave
When viewing the phalanx, one would note that all proximal articulating surfaces are ____ and all distal articulating surfaces are ____. A. concave; concave B. concave; convex C. convex; concave D. convex; convex
D. Pad-to-pad prehension
Which of the following is NOT a power grip? A. Cylindrical grip B. Hook grip C. Lateral prehension D. Pad-to-pad prehension E. Spherical grip
Capitate
Which of the following is NOT a proximal carpal bone? A. Capitate B. Lunate C. Scaphoid D. Triquetrum
arthokinematics: extension and flexion
Wrist extension: Simultaneous convex-on-concave rotations at both radiocarpal and midcarpal joints Kinematics occur as roll and slide in opposite directions simultaneously at radiocarpal and midcarpal joints
B. Pain with proximal interphalangeal (PIP) flexion more than distal interphalangeal (DIP) flexion
Your patient has had a tendon laceration of the third finger flexor tendons. Which impairment would indicate more damage to the FDS versus the FDP tendon? A. Pain with resisted distal interphalangeal (DIP) flexion more than proximal interphalangeal (PIP) flexion B. Pain with proximal interphalangeal (PIP) flexion more than distal interphalangeal (DIP) flexion C. Pain equal with proximal interphalangeal (PIP) and distal interphalangeal (DIP) flexion D. Pain with resisted metacarpophalangeal flexion.
carpal tunnel
a tunnel formed by the distal row of carpals that is concave anteriorly and houses the long finger flexor tendons and median nerve
palmar tilt
allows for more flexion than extension; looking at distal radius ulna joint - ulnar tilt is radius is tilted ulnarly 25° allowing for more ROM.
anatomical snuffbox
an area formed by the tendons of the thumb located on the lateral surface of the hand
flexion
anatomical position, bone moves anterior, open chain, convex proximal carpal bones and concave radius, glide is posterior
radiocarpal joint
approximately 80% of force that crosses wrist passes through scaphoid, lunate, and radius
pronation and supination
are motions of forearm - not hand or wrist
arthrokinematics: midcarpal joint
articulation between lunate and capitate, scaphoid
arthrokinematics: radiocarpal joint
articulation between radius and lunate and scaphoid
TFCC
attaches to the distal end of the radius and the styloid process of the ulna proximally and the apex attaches to the triquetrum distally; binds radius and ulna together;
midcarpal joint
most prominent articulation is formed between head of capitate and socket formed by distal surfaces of scaphoid and lunate
opposition
movement of the thumb or fifth finger across the palm of the hand
reposition
movement of the thumb or fifth finger back to neutral from opposition
radial deviation
movement of the wrist, hand or fingers laterally toward the radius
ulnar deviation
movement of the wrist, hand or fingers medially toward the ulna
extrinsic muscles
muscles that insert in the hand but originate proximally outside of the hand
intrinsic muscles
muscles that originate and insert in the hand
wrist instability
normally, wrist remains stable when compressed, even under substantial forces
osteokinematics
of wrist involve flexion and extension and ulnar and radial deviation; wrist doesn't spin; portions of radiocarpal joint naturally block this twisting motion
carpal tunnel
partly formed by transverse carpal ligament bridging palmar side of carpal bone; serves as passageway that helps protect median nerve and tendons of extrinsic flexor muscles of digits; prevents bowstringing of tendons anteriorly;
median nerve
peripheral nerve also have areas of sensation. Supplies 3 1/2 palmar aspect (thumb, pointer, middle, and half the ring finger)
palmar
pertaining to the anterior surface of the hand
hypothenar
pertaining to the muscles of the fifth finger
Thenar
pertaining to the muscles of the thumb
dorsal
pertaining to the posterior surface of the hand
lunate
prone to dislocation
radiocarpal joint
proximal part consists of biconcave surface of radius and adjacent articular disc
Closed and Loose Packed Positions Distal Radioulnar: closed packed
5° supination
scaphoid
most commonly fractured; broken due to foosh (fall on outstretched hand)
Arthrokinematics: Distal Radioulnar Joint
Concave ulnar notch on radius Convex Ulnar head
C. wrist flexion; radial deviation
Contraction of the flexor carpi radialis produces ____________. Co-contraction of the flexor carpi radialis and extensor carpi radialis produces ____________. A. radial deviation; wrist extension B. radial deviation; wrist flexion C. wrist flexion; radial deviation D. wrist flexion; ulnar deviation
extension
Full wrist extension elongates palmar radiocarpal ligaments, palmar capsule, and wrist and finger flexor muscles Helps stabilize wrist in extended position; useful when weight is borne through upper extremity
C. radius/ulna to the carpals
Ligaments of the wrist are described as extrinsic or intrinsic. By definition, extrinsic ligaments attach: A. metacarpals to the phalanges B. phalanges to the carpals C. radius/ulna to the carpals D. within the carpals
A. extension; anterior
Mary fell on an outstretched hand and fractured her distal radius. After the cast is removed, she does not have a functional grip. To increase her grip, you should work on wrist ____________ by gliding the proximal carpals ____________ on the radius. A. extension; anterior B. extension; posterior C. flexion; anterior D. flexion; posterior
Ulnar and Radial Deviation of Wrist
Motions of ulnar and radial deviation occur through simultaneous convex-on-concave rotations, at both radiocarpal and midcarpal joints
C. Flexor carpi ulnaris (FCU), flexor digitorum superficialis (FDS), pollicis longus (PL), flexor pollicis longus (FPL), flexor carpi radialis (FCR)
Palpating from medial to lateral, the tendons of the wrist are: A. Flexor carpi radialis (FCR), flexor pollicis longus (FPL), pollicis longus (PL), flexor digitorum superficialis (FDS), flexor carpi ulnaris (FCU) B. Flexor carpi radialis (FCR), pollicis longus (PL), flexor pollicis longus (FPL), flexor digitorum superficialis (FDS), flexor carpi ulnaris (FCU) C. Flexor carpi ulnaris (FCU), flexor digitorum superficialis (FDS), pollicis longus (PL), flexor pollicis longus (FPL), flexor carpi radialis (FCR) D. Flexor carpi ulnaris (FCU), pollicis longus (PL), flexor digitorum superficialis (FDS), flexor carpi radialis (FCR), flexor pollicis longus (FPL)
Arthrokinematics: Distal Radioulnar Joint
Pronation: Concave radius on convex ulna-concave ulnar notch glides anteriorly on the ulnar head
Ulnar and Radial Deviation of Wrist
Radial deviation at wrist is limited; radial aspects of carpal bones abut against styloid process of radius, thereby limiting extent of radial deviation across wrist
wrist extension and finger extension
The muscles found on the posterior surface of the forearm are known to participate in: A. wrist extension and finger extension B. wrist extension and finger flexion C. wrist flexion and finger extension D. wrist flexion and finger flexion
A. has greater finger spread with more interosseous activity
The primary difference in muscle activity between the cylindrical and the spherical grip is that the spherical grip: A. has greater finger spread with more interosseous activity B. has greater finger spread with more lumbrical activity C. has less finger spread with less interosseous activity D. has less finger spread with less lumbrical activity
A. ulna, lunate, triquetrum
The structures that surround the triangular fibrocartilage complex are: A. ulna, lunate, triquetrum B. ulna, pisiform, hamate C. ulna, scaphoid, lunate D. ulna, triquetrum, hamate
carpal tunnel
The transverse carpal ligament provides a ceiling for the: A. carpal tunnel B. metatarsal tunnel C. radial tunnel D. ulnar tunnel
triquetrum
The triangular fibrocartilage complex can be found between the ulna and: A. capitate B. hamate C. trapezium D. triquetrum
14
There are ____ phalanx in each hand. A. 10 B. 12 C. 14 D. 15
ulnar translocation
bones shifted ulnarly because the bones are angled that way and there's more space.
wrist instability
damage from large force (a fall) or typical wear and tear from aging can significantly destabilize this region or Rheumatoid Arthritis
radiocarpal joint
distal part consists primarily of the convex articular (proximal) surfaces of scaphoid and lunate
sagittal plane: flexion and extension
extension limited by tension in thicker palmar carpal ligaments and carpal bones making contact with dorsal side of distal radius
TFCC
fills space - runs form radius to ulna to triquetrium
end feel
firm for wrist flexion, extension, ulnar deviation; hard for radial deviation
distal radius and ulna
form a concavity that articulates with the convex (proximal) row of carpal bones; concavity is bordered laterally by the radial styloid process and medially by the ulnar styloid process
sagittal plane: flexion and extension
from neutral position, wrist flexes about 70-80° and extends about 60-65°
frontal plane: radial and ulnar deviation
from neutral position: full ulnar deviation allows about 30-35°; radial deviation allows about 1-20°
PTA
goals for a weak, painful wrist typically include strengthening, relief of pain, education on ways to protect the wrist, and splinting
intrinsic ligaments
have both proximal and distal attachments located within carpal bones; origin is inside the area
extrinsic ligaments
have proximal attaches outside carpal bones but attach distally within carpal bones; origin is outside the area
hamate
hook (fractured easily by golfers)
intrinsic ligaments
interconnect various carpal bones, help transfer forces between hand and forearm; maintain natural shapes of radiocarpal and midcarpal joints, thereby minimizing joint stress during movement.
carpal tunnel
is due to swelling in small area
maximum ulnar deviation
is normally twice that of radial deviation, mostly because of void created by ulnocarpal space and the bones are angled that way
midcarpal joint
joint between two rows of carpals
capitate
largest carpal bone, central location and serves as axis for motion (axis for wrist)
wrist instability
ligaments weakened by injury or disease lead to instability or collapse of the wrist (intrinsic or extrinsic ligaments)
ulnocarpal space
relatively wide space between distal ulna and ulnar carpal bones; helps buffer forces that cross wrist
dorsal radiocarpal ligament
resists extreme of flexion; attaches between radius and dorsal side of carpal bone
ulnar collateral
resists extremes of radial deviation; helps stabilize distal radioulnar joint; part of ulnocarpal complex/part of TFCC
radial collateral ligament
resists extremes of ulnar deviation; strengthened by muscles such as abductor pollicis longus and extensor pollicis brevis
palmar radiocarpal
resists extremes of wrist extension; thickest ligament of wrist
capsular pattern
restricted equally in all directions
arthrokinematics: carpometacarpal joint
rigid articulation between capitate and base of third metacarpal
carpal instability
rotational collapse "zigzag" deformity; ulnar translocation of the carpus
axis
runs medial-lateral for flexion and extension and anterior-posterior for radial and ulnar deviation
trapezium
saddle shaped allowing for wide ROM of thumb
proximal row carpal bones
scaphoid, lunate, triquetrum and pisiform, loosely joined, strong ligaments tightly bind distal row
midcarpal joint
separates proximal and distal rows of carpal bones
TFCC
separates the distal RU joint and the ulna from the radiocarpal joint
arthrokinematics: central wrist column
series of articulations, or links, between the radius, lunate, capitate, and third metacarpal bone
pisiform
sesamoid bone within tendon of FCU
loose-packed
slight palmar flexion (10°) and slight ulnar flexion
trapezoid
stable base for 2nd MC
rotation of capitate
to direct overall path of entire hand
sagittal plane: flexion and extension
total flexion normally exceeds extension by about 15°
distal row carpal bones
trapezium, trapezoid, capitate, and hamate; stability provides an important rigid base for articulations with metacarpal bones
triquetrum
triangular appearance
TFCC
triangular fibrocarilaginous complex
radiocarpal joint
ulnar-located carpal bones and distal ulna are less likely to fracture from falls because they are not in the direct path of weight bearing
close-packed
wrist in maximal extension with radial deviation
ligaments
wrist joints are enclosed within fibrous capsule, thickened by extrinsic and intrinsic ligaments
